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SSL \,,SK , SHIP#:: 229289944 P ase print or type. Form Approved . OMB No. 2050.0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. me Res 14. Manifest Trac ng Number WASTE MANIFEST CAL000413716 �# ^ —4 1% 007158869 SKS 5, Generator's Name and Mailing Add Generator's Site Address (d different than mailing address) r " Caliber Collis ion -- Stockton # 1060 3210 N Wilson Way Location ID# — 1060 STOCKTON CA 95205-0000 Generatoes.Phone: 209-469^-7091 U.S. EPA ID Number 6. Tr � SYSTEMS INC TXR0000 IM 7. Transporter 2 Company Name _ U.S. EPA ID Number CLEAN HARBORS ENV SVC INC . MAD039322250 8, Designated Facility Name and Site Address CLEAN HARBORS ENVIRONMENTAL SERVICES , IN U.S. EPA ID Number 2247 S HIGHWAY 71 KIMBALL NE 69145 308^235-4012 WD961723513 ` r Facility's Phone: ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13. Waste Codes HM and Pacldng Group (d any)) No. Type Quantity WtJVol, X 1 ' LNV3175 WASTE SOLIDS CONTAINING DM � � � P F00 F005 0001 FLAMhIALE LIQUID N. O. S . ( TOLUENE , aa, METHYL. ETHYL KET ) , 4 . 1 , PG II DO 0006 352 w X 2. , �(�/ TI 3. 4. to 14, Special Handling Instructions and Additional Information TSD : KP 80924329 CA65817 CSS : 1 ) ERG# 133 . 2 ) ERG# 128 • 24H EMERGI 'NCY11800-498- 1760--CH / SK / TFI -Contract retained by generator confers agency authari y n initial transporter to add or subatitute additional transpartgrs an a nerator' s behalf , 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeledlplacarded , and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations. If export shipment and I am the Primary 1 Exporter, f certify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (if I am a small quantity generator) is true. GsneratoesiOiferor Pdnted/Typed pme W" Signature Igh Day Year 4met , Of `JAL YY r . r 116, International Shipments El import to U.S. ❑ Export from V.S}j Port of entryfexit: a . Transporter signature (for exports only): Date leaving U.S.: W 17, Transporter Admowledgment of Receipt of Materials N000mmowl TraXer 1 Prin5 Same Signature M9Wh �K a 11 . � (�,(,� •�C1� - TRW 2P ' ame Signa Month Day Year ir 18, Discrepancy 18a, Discrepancy Indication SpaceQuantify ❑ Type ElResidue Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b, Alternate Facility (or Generator) U.S. EPA ID Number J rJ t"t+. Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year 19. Hazardous Waste Report Managemen Method Codes (9.e., codes for hazardous waste treatment, disposal, and recycling systems) 20. Designated Facility Ownee* Operator. Certification of receipt of hazardous materials covered by the manifest oxcept as noted in Item 18a PrintedRypedName • , .�:. (~' Sig r t�oglh Da r EPA j r i�740 2� (Rev 1022lgr7lous a it ! s�hsol 4 DESIGNATED FACILITY TO GE ERATOR 1 9�4►�t8&. .. 1 �7 ��.. i E